Source: Children’s Health Defense

Mainstream media outlets are touting a study published May 30 in JAMA Health Forum that predicts ending water fluoridation will worsen children’s oral health and increase national dental healthcare costs.

The study is the most recent attempt by researchers with links to pro-fluoridation lobbying groups like the American Dental Association (ADA) to undermine public confidence the growing body of scientific evidence that water fluoridation has negative consequences for children’s health.

The study was published by Harvard’s Sung Eun Choi, Ph.D., and Brigham and Women’s Hospital’s Lisa Simon, M.D., D.M.D. Simon receives funding for other research from the ADA, the California Dental Association and other pro-water fluoridation groups, according to the study’s conflict-of-interest disclosures.

Choi and Simon estimated that If everywhere else in the U.S. were to stop fluoridating water, in the next five years, 7.5% more U.S. children ages 0-19 would get cavities — a total of 25.4 million additional teeth would be affected — and it would cost a total of $9.8 billion to treat them.

They also claimed that the number of cavities would more than double in 10 years, to 53.8 million.

The authors argue in the paper and in the press that stopping water fluoridation would disproportionately affect low-income children who are often on Medicaid or without insurance.

Leading fluoride expert Kathy Thiessen, Ph.D., told The Defender there is no good evidence that water fluoridation helps low-income people — it’s just “wishful thinking,” she said, used to justify water fluoridation.

She added:

“Caries development is probably far more related to diet (e.g., sugar) and nutrition (adequate calcium, protein, vitamins) than to fluoride or dental hygiene. That generally translates to higher income, better dental health; lower income, worse dental health.

“The U.S. would be much better off if the money spent on promoting and implementing fluoridation were spent on providing dental care, nutrition, etc., for the lower socioeconomic groups.”

The study authors acknowledged the recent research showing that fluoride exposure has serious negative consequences for children’s neurodevelopment. However, they said that because current federal guidelines haven’t changed to account for such damage, they didn’t consider it in their model.

They didn’t mention that the U.S. Environmental Protection Agency (EPA) is a under court order, which it has yet to appeal, to revise its water fluoridation regulations to account for this risk to children.

Instead, they cited editorials published by members of the ADA and its National Fluoride Advisory Committee, challenging two studies on fluoride’s neurotoxicity to downplay their importance.

Experts on fluoride’s neurotoxic effects who spoke with The Defender were highly critical of the study’s failure to consider fluoride’s neurotoxic effects on children.

Dr. Hardy Limeback, former head of preventive dentistry at the University of Toronto and a fluoride expert said, “Banning fluoridation is a step closer to children’s overall health.”

“Why damage 75 million kids’ brains or the appearance of 9 million kids’ smiles, just to try and save maybe 25 million teeth — if that’s even close to a reliable number — from dental decay?” he asked.

Theissen said the study’s authors don’t include any of the significant costs that result from fluoride’s neurotoxic effects — ranging from immediate healthcare costs, to costs of therapy for disorders such as autism or ADHD, to lifelong earnings reductions associated with lowered IQ.

“A responsible cost-effectiveness analysis really should have included cognitive effects and other adverse effects,” she said.

Fluoride added to drinking water a byproduct of phosphate fertilizer production

Fluoride has been added to community water supplies in the U.S since the 1940s, on the assumption that it would improve children’s dental health.

For decades, scientists and community activists have been raising concerns that fluoride is linked to reduced IQ, behavioral issues, disruption of thyroid functioning and disruption of the gut microbiome.

However, it wasn’t until consumer advocacy groups who sued the EPA in federal court to end water fluoridation won their landmark lawsuit last year that the issue generated national attention.

Soon after Judge Edward Chen ruled that water fluoridation at current U.S. levels poses an “unreasonable risk” of reduced IQ in children and that the EPA must take regulatory action, numerous communities across the country organized campaigns to stop fluoridating their water.

Although most media reports highlight that fluoride is a “naturally occurring mineral,” the fluoride added to water supplies is not.

The fluoride most commonly added to U.S. drinking water supplies is hydrofluorosilicic acid, the byproduct of phosphate fertilizer production, sold off by chemical companies to local water departments across the country.

Overwhelming scientific research shows that fluoride’s benefits to teeth are topical, not the result of ingesting fluoride, and a 2024 Cochrane Review found adding fluoride to drinking water provides very limited dental benefits, especially compared with 50 years ago.

Experts question new study’s model, assumptions and ‘sloppy’ errors

Thiessen called the new JAMA paper “somewhat sloppy,” and cited several outright errors she said reviewers should have caught. She pointed out that the authors confused the roles of different regulatory agencies, provided incorrect citations for some of their model input numbers, and sometimes used outdated cost estimates.

To estimate the effects of ending water fluoridation, the authors created a nationally representative sample using data from 8,484 children, from birth through age 19. The data came from the National Health and Nutrition Examination Survey, which is conducted each year by the CDC and is based on interviews about diet and details from people’s health records.

The study authors used current water fluoridation levels as a proxy for how much fluoride children are exposed to, then predicted the increase in cavities that would occur if that were to stop.

Their model predicted two scenarios: if every public water system fluoridated its water at today’s recommended level of 0.7 milligrams per liter, and if there were a total national ban.

Experts questioned the use of fluoride in water as a proxy for exposure, given that children are exposed to fluoride from many sources other than drinking water, including toothpaste and all processed foods and drinks made with fluoridated water.

They also criticized the “total ban” scenario, in which the researchers estimated that fluoride levels would be reduced to zero in all systems. According to the CDC, almost all water contains some naturally occurring fluoride, so the zero fluoride estimate scenario can’t occur.

It was also “assumed” that children benefit from drinking fluoridated water, but Thiessen said there is no basis for this assumption.

“We badly need some honest and thorough evaluation of whether there is a benefit or not from fluoride or fluoridation,” she said. “If there is no real benefit, then obviously any risk of adverse health effects is not justified.”

The only negative health effect of water fluoridation the researchers considered was dental fluorosis — a discoloration of the teeth that occurs when a child is overexposed to fluoride.

Even their estimate of how many children would have “objectionable” dental fluorosis “completely missed the mark,” Limeback said. According to the Cochrane Review cited by the researchers, every eighth child in fluoridated areas has dental fluorosis that needs repair, Limeback said. Ending fluoridation would result in 9,375,000 (not 200,000 as they reported) fewer cases of dental fluorosis.

Each case of serious fluorosis costs between $2,000 and $20,000 to repair, he said, meaning that ending fluoridation offers potential savings of $18.75 to $187.5 billion dollars.

“America would drastically reduce the dental fluorosis epidemic in the U.S. if all the states banned water fluoridation.”

Thiessen also noted that the authors disregarded other costs borne by the American public associated with water fluoridation, including the costs of fluoridating, and the costs of cleaning up fluoridation overfeeds and spills, which are common, and addressing the health issues they cause.

“I also expect that other health issues will decrease substantially, more than making up for any increase in dental costs,” Thiessen added.

Related articles in The Defender: 

• Breaking: New Cochrane Review Finds Water Fluoridation Has Minimal Effect on Dental Health
• Lobbyists for Pediatricians and Dentists Dig in on Water Fluoridation
• Profanity-laced Emails, Misuse of CDC Funds: How Big Fluoride Tries to Prevent Towns From Removing Fluoride
• That Fluoride Added to Your Town Water to ‘Prevent Cavities?’ The EPA Says It’s Hazardous Waste